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What Drives Successful Reperfusion After Fibrinolysis? Insights into Timing, Cardiac Injury, Inflammation and Haemodynamic Status
Session:
Sessão de Posters 43 - Da disseção da artéria coronária às decisões antitrombóticas e de reperfusão nas síndromes coronárias agudas
Speaker:
Margarida Câmara Farinha
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Margarida Câmara Farinha; Inês Barroso Almeida; Inês Coutinho dos Santos; Fabiana Duarte; Maria Inês Barradas; Luis Oliveira; Carina Machado; Nuno Pelicano; Emília Santos; António Fontes; André Viveiros Monteiro; Miguel Pacheco
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> In remote locations, fibrinolysis remains a valuable strategy in ST-Elevation Myocardial Infarction (STEMI) patients. Identifying reliable predictors of fibrinolytic success is essential to optimize decision-making.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> To determine independent clinical and biochemical predictors of successful reperfusion following fibrinolysis in STEMI patients.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> We retrospectively analysed consecutive STEMI patients who underwent fibrinolysis and were subsequently transferred to our center for facilitated or rescue percutaneous coronary intervention (PCI) between 2020 and 2023 (n=154). Clinical, laboratory and timing variables were collected. Reperfusion success was defined by ≥50% ST-segment resolution accompanied by symptomatic improvement and pre-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade ≥2 in coronarography. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> Successful reperfusion was achieved in 64.9% of patients. In univariate analysis, shorter symptom-to-fibrinolysis times was strongly associated with reperfusion success (median 2.12 vs 3.55 hours; p=0.027). Chronic antiplatelet therapy was also a predictor of reperfusion (26% vs 5.6%; p=0.002). Higher Killip class III–IV was more frequent among patients without reperfusion (29.6% vs 13%; p=0.012). Patients without reperfusion also had markedly higher initial troponin levels (median 163 vs 24.5 ng/L; p<0.001) and higher C-reactive protein concentrations (median 1.27 vs 0.54 mg/L; p<0.001). In contrast, age, sex, body mass index and common cardiovascular comorbidities, including hypertension, diabetes and dyslipidaemia, showed no significant association with reperfusion status (all p>0.05).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">In multivariable analysis, independent predictors of successful reperfusion were shorter symptom-to-fibrinolysis time (per 30-minute increase: OR 0.78; p=0.02), lower initial troponin (log-TnI: OR 0.40; p =0.004), lower C-reactive protein (log-CRP: OR 0.47; p=0.009) and absence of Killip class III–IV (OR 0.34; p=0.028). Chronic antiplatelet therapy remained a strong and independent predictor of reperfusion success (OR 6.92; p=0.006).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> Lower myocardial necrosis, inflammation burden and Killip Class, as well as pre-existing antiplatelet therapy independently predict fibrinolytic success. This easily obtainable data could help identify patients more likely to respond to fibrinolysis and could support decision-making regarding the optimal strategy and timing of subsequent coronary angiography.</span></span></p>
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